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              -  Home 
              -  Rail Employer Reporting Instructions (RERI) 
              -  Appendices 
              -                   Appendix II: Pay for Time Lost Worksheet              

## Topics

-  Part I - Prerequisite Knowledge for Rail Employer Reporting  
-  Part II - Establishment of Employee Records 
-  Part III - Principles of Service and Compensation 
-  Part IV - Particular Types of Compensation Payments 
-  Part V - Reports of Creditable Service and Compensation 
-  Part VI - Reports Related to Service and Compensation 
-  Part VII - Additional Communications about Service and Compensation Reports 
-  Part VIII - Employer Reporting System (ERS) Internet User Instructions 
-  Appendices    -  Appendix I: Electronic File Formats 
  -  Appendix II: Pay for Time Lost Worksheet 
  -  Appendix III: Railroad Retirement Board Jurisdiction Guide 
  -  Appendix IV: Table of Earnings Bases and Tax Rates 
  -  Appendix V: Understanding Edit Checks of Tier I and Tier II Compensation 
  -  Appendix VI: Service and Compensation Referrals to Employers 

 

RERI-App. II_Pay for Time Lost Worksheet
 

Section 1: Identifying Information

 

Employee’s Name: _________________________SSN: __________________________

 

## Section 2: Service Month Allocation

The allocation must relate to the actual period of absence from service due to the injury.

 

**A.**  Date of Injury: ___________       **B.**  Reported Service Months to Date: ___________

                                                                  (Exclude Deemed Service Months in or after the year of Injury)

**C.**  Service Months needed to attain: 120_______   240_______   360_______

 

**D.**  Service Month Allocation:

              Year                   Allocated Months                Total

 

            ______              J F M A M J J A S O N D      _______

 

            ______              J F M A M J J A S O N D      _______

 

           ______              J F M A M J J A S O N D      _______

 

           ______              J F M A M J J A S O N D      _______

 

           ______              J F M A M J J A S O N D      _______

 

           ______              J F M A M J J A S O N D      _______

 

                     **E.**   Total Allocated Service Months:     _______

 

                     **F.**   Service Months to Date:                +_______

                                                                                     (2B) 

                     **G.**  Projected Total Service Months:  = _______

 

## Section 3: Minimum Creditable Compensation Calculation

The monthly compensation allocation must be at least ten times the employee’s daily pay rate in effect on the first day to which Pay for Time Lost payments relate**.**

 

**A.**  Employee’s Daily Pay Rate: _______

 

**B.**  Minimum Monthly Compensation:

         Employee Daily Pay Rate__________ x 10 = ___________

                                                    (3A)

**C.**  Total Allocated Compensation:

Minimum Monthly Compensation __________ x Total Allocated Service Months__________ = _____________                            

                                                         (3B)                                                            (2E)

 

**Section 4: Railroad Retirement Tax Act Calculation**

Pay for Time Lost compensation is subject to the Tier I, Tier II and Medicare tax rates in effect when the payment is made.  Annual maximum earnings bases apply to Tier I and Tier II taxes.

 

# Employer Tax Calculation:

Tier I Taxable Compensation ___________ x___________ % = ___________ Tier I Tax

 

Medicare Taxable Compensation________ x_________ % = ___________ Medicare Tax

 

Tier II Taxable Compensation __________ x___________ % = ___________ Tier II Tax

 

Total Employer Tax ___________

 

Employee Tax Calculation:

Tier I Taxable Compensation ___________ x___________ % = ___________ Tier I Tax

 

Medicare Taxable Compensation________ x_________ % = ___________ Medicare Tax

 

Tier II Taxable Compensation __________ x___________ % = ___________ Tier II Tax

                                                          

Total Employee Tax ___________

 

## Section 5: Railroad Unemployment Insurance Act Employer Contributions

RUIA contributions are calculated using the rates and monthly limits in effect during the months the Pay for Time Lost payments relate.  RUIA creditable compensation is calculated by multiplying the service months allocated to the year by the lesser of the applicable RUIA monthly maximum or the employee’s allocated monthly compensation.

 

                        RUIA Creditable         Contribution            RUIA

 Year                 Compensation     x         Rate         =  Contribution

 

 _____              ______________  x    ________   =   ____________

 

 _____              ______________  x    ________   =   ____________

 

 _____              ______________  x    ________   =   ____________

 

 _____              ______________  x    ________   =   ____________

 

 _____              ______________  x    ________   =   ____________

 

 _____              ______________  x    ________   =   ____________

 

        Total Employer RUIA Contribution ____________

 

For a general overview of the topic, see Form IB-4, “Pay for Time Lost from Regular Railroad Employment”.

   

**‹** Appendix I: Electronic File Format, Form BA-15, Report of Stock Options and Other Payments
Up
Appendix III: Railroad Retirement Board Jurisdiction Guide **›**

   

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								Last updated: 06/02/2017